CARDIO Flashcards
3 Heart defects associated with increased pulmonary blood flow?
ASD (atrial septal defect
VSD
PDA
which congenital heart defects are associated with decreased pulmonary flow?
Tricuspid atresia
Tetralogy of Fallot
GI or organ s/sx of Congestive HF?
poor feeding
enlarged liver/edema
s/sx of congestive HF
poor feeding/growth
SOB/Sweating
peripheral edema
how does peripheral edema present in children
puffy eyelids
swelling of hands/feet
bulging fontanelle
what are “staple” clinical manifestations of L & R sided congestive heart failure?
pulmonary congestion (Left sided = lung)
Systemic venous congestion (R sided)
s/sx of pulmonary congestion
tachypnea, dyspnea, respiratory card, exercise intolerance, cyanosis
s/sx of systemic venous congestion
peripheral & periorbital edema, weight gain, ascites w/ neck vein distention
what 3 meds(&their type) would you give for congestive HF?
Digoxin
Furosemide - Lasix (diuretic)
Captopril (vasodilator)
what is Digoxin used for in HF?
When poor contractility is the cause of HF
s/sx of Digoxin toxicty?
N/V
Blurred vision (halos)
yellow/green distortion
confusion/vertigo/convulsion
treatment for dig toxicity?
Stop meds immediately
Digi Fab
Activated charcoal
cyanotic defects mechanism
DeO2/venous blood from R side is forced into L
overall O2 will drop (as low as 70)
acyanotic defect mechanism?
O2 blood shunts from the L to the R
This type of mixing doesnt affect the amount of O2 in the body - wont change O2 sat
what is atrial septal defect?
Septal overlap & defect btwn R/L atrium
s/sx for atrial septal defect?
Periorbital edema
increased respiratory infections
Harsh systolic murmur
R atrial enlargement from fluid overload
why are ASD pt’s at risk for stroke?
Tendency for blood pooling
where is ASD murmur heard at?
2nd IC L sternal border
what is a ventricular septal defect & when does it form?
hole in ventricular septal wall (lower portion)
4-8wk
blood movement thru VSD?
O2 (red) blood pass abnormally from L ventricle thru septal opening mixing with O2poor(blue) blood
what can physical change to heart can happen from the mixing of bloods/abnormal flow from VSD?
RV overload from high pressure gradient of L to R
s/sx of VSD?
Harsh Murmur w/thrill
Pansystolic
Easy fatigue
Poor growth
what does VSD murmur sound like & where?
harsh & Lower L sternal border
is the ductus a normal part of infant anatomy?
Y
what happens in patent ductus arteriosus?
too much blood flow to lungs
O2 rich blood flows from aorta to mix with O2poor blood in PA
what physical/visual s/sx would you see with PDA?
bounding pulses
what happens to PDA BP?
widening pulse pressure
medication for PDA? & why
Indomethacin (Indocin)
Keep PDA open
s/sx of PDA?
Machine like harsh murmur
what would you physically see in PDA?
Bounding pulse
care for PDA
Fluid restriction (diuretics)
indomethacin
edu for mom about PDA?
mom cant take ibu - bc its a prostaglandin inhibitor
what is coaractaition of aorta?
“sausage defect”
narrowing of descending aorta distal to carotid arteries
what physical change to heart & body effect happens from coaractaition of aorta?
L ventricle hypertrophy
&
Impeded circulation to LE ONLY!
s/sx of coaractation of aorta
increased pressure to Head/UE
Pain in legs/cyanotic LE
Decreased pressure to LE
what is the characteristic sign of coaractation of aorta
BP in LE is >10mmHg less than UE
Coaractation of aorta murmur is?
Isnt always present
systolic ejection murmur @ UR/L sternal border
what is the official diagnosis of CoA?
pressure differential btwn arms/legs
Care for CoA?
May have rebound HTN - give antihypertensives for 6months to 1Y
ex of meds given for COA
Captopril & Enalapril (Vasotec)
- they reduce afterload & control BP
what is the surgical treatment for CoA?
Stent placement & balloon angioplasty
what type of heart defect is Tricuspid Atresia?
cyanotic
what is tricuspid atresia (TA)
error in tricuspid valve = no blood reaches lungs
what are the s/sx of TA?
Dramatic!
Severe cyanotic/dyspneic
Heart murmur present at L sternal border
what type of murmur is present in TA?
Pansystolic
care & surgery for TA?
Prostaglandins to keep PDA open
Balloon atrial septoplasty
Glenn procedure & Fontan procedure
what type of defect is Pulmonary Atresia? (PA)
cyanotic
what is pulmonary atresia?
Absence of pulmonary valve, pulm artery or both
What other condition(s) must a child have to live with PA?
ASD, PDA
PDA = blood flow into lungs for oxygenation
treatment for PA?
PGE (prostaglandins)
Atrial septostomy
shunt/conduit
what is total anomalous pulmonary venous return?
pulm blood flow returns to heart thru R atrium rather than the L
what can the mixing of blood in TAPV cause?
Cyanosis
s/sx of total anomalous pulm venous return?
systolic ejection murmur heard @ pulmonic area
R sided hypertrophy
respiratory distress = frequent resp infections
treatment for TAPV
Complete surgical repair
post surgery education for TAPV?
can live normal life post surg
follow up PCP Q1-2y
what is transposition of the great arteries/vessels
aorta rises from the R side of the heart & the PA is on the L
what is the surgery for transposition of great arteries/vessles?
arterial switch operation
s/sx of transposition of great arteries?
Cyanosis
SOB
clubbing of fingers/toes (!!)
what is truncus atreiosus?
Neither trunk has formed a septum
PA’s & Aorta are combined
classified I-IV
treatment for TA
aggressive medical regiment w/ Inotropic medication
s/sx of truncus ateriosus?
low cardiac output
systolic ejection murmur
what is tetralogy of fallot?
combo defect made up of 4 diseases
what are the 4 diseases from tetralogy of fallot?
PROV
P: Pulm stenosis
R: R ventricle hypertrophy
O: Overriding aorta
V: Ventral septal defect
walk thru of tetralogy of fallot?
Starts as outflow disorder w/ pulm stenosis, blood cant exit properly thru R side of heart & turns into RV hypertrophy
s/sx of TOF?
Dyspnea on exertion
Harsh/loud/radiating murmur
RV hypertrophy
what can happen with tetralogy of fallot?
“TET” spells
what are TET spells?
turn blue when crying/excitement
drop in oxygenation in periphery
hallmark sign for TOF?
Cyanosis when crying/playing
Can lead to fainting
what can be given to children in TET spells?
Morphine (in hospital)
position for TET spells?
Child in knee to chest position during episode
older children go into squat
s/sx of TOF?
tachypnea
dyspnea on exertion
loud systolic ejection murmur thats “harsh”
what is hypoplastic L heart syndrome
ventricle is extremely small & can’t maintain adequate cardiac output
not enough oxygenated blood
medication for hypoplastic L heart syndrome
prostaglandins to keep PDA open
procedures for HLH
Norwood & blaock taussing shunt
eventually Glenn for more blood flow
feeding edu about cyanotic conditions?
small frequent feedings
use soft nipple to ease stress of sucking
mom can pump breastmilk if infant lacks strength
what to monitor when giving Digoxin
Apical HR for 1 full minute
what can fluid retention indicate in cyanotic?
right sided heart failure
what pulse do you hold digoxin for?
infant: Under 90
1-9: <70
10+: 60
what electrolyte should today when given lasik for cyanotic care?
Potassium (K)
infant blood pressure range
65-100 / 55-65
toddler BP range?
90-105 / 55-70
pre-school BP range?
95-110 / 60-75
what med would you administer for a child hospitalized with heart failure & extremely high BP?
Enalapril (Vasotec)
what test would a child presenting with neurally mediate syncope be given?
Tilt table test
if a 4 year old presents with a systolic BP of 112, whats the next response?
refer to a provider (20 mg too high)
where would the murmur be for PDA?
L subclavian border
what skin symptom presents in kawasaki disease?
erythema marginatum rash
a child with suspected Rheu fever, how are they diagnosed?
JONES
criteria
what is often the cause of rheumatic fever?
Group A Beta hemolytic strep phargyn
Hx of strep & chronic pharyngitis
what medication is given for rheumatic fever?
Amoxicillin/penicillin
Aspirin
edu for rheumatic fever long term effects?
may need valve replacement
in the JONES criteria, what is a standout development for rheumatic fever?
a new murmur without ever having one.
what disease presents with a harsh murmur w/ thrill @ L lower sternal border
ventricular septal defect (VSD)
what type of patient would you hesitate/further evaluate when giving digoxin?
One retaining fluid (weight gain over short period)
what is pulmonary stenosis?
malformation/narrowing of pulmonic valve/artery
narrowing of the pulmonic valve causes what in the heart?
CHF & hepatomegaly of RV
2 conditions PS is associated with?
Noonon syndrome
TOF
age most cases of pulmonary stenosis is caught? (when heart muscle is more developed)
3y
what manifestations are present with PS?
murmur
crying, exercise or fever induced dyspnea
when would a child with PS experience dyspnea?
Increased BP from:
Excitement
Exercise
Crying
Fever
how to diagnose PS?
ECG showing RV hypertrophy
how is surgical care of PS based?
Gradient
Observation of child over period of time “Watch & wait”
what is Kawasaki disease?
systemic vasculitis of unknown cause (thought to be bad immune resp)
Long term Sequela of Kawasaki?
arterial vessels aneursym & myocarditis
S/sx of Kawaski?
Fever up to 104 for 5 days
unilateral lymphadenopathy
strawberry tongue
conjuctivitis without exudate
red maculopapular rash
blood tests run to diagnose Kawaski?
CBC, Erythrocyte sedimentation (ESR)
edu about taking medication w/ Kawasaki?
Monitor closely if on anticoagulant = at risk of bleeding/bruising
Kawasaki treatment?
High dose aspirin & IVIG
edu about vaccines & kawasaki?
can’t get live virus vaccine bc of IVIG
what food should a patient avoid post op a tonsilectomy
milk/dairy
it increases secretions
what are 3 expected side effects of tamiflu?
vomiting
unusual behavior
hallucinations
what is an unexpected side effect of tamiflu?
dilated pupils
what would the primary nursing intervention be for transposition of the great arteries?
administering prostaglandin E1 - keep ductus arteriosus open
which heart defects are given prostaglandin E to keep the PDA open?
Hypoplastic left heart
transposition of G Vessel
CoA
what is a priority nursing intervention for a foreign body aspiration w/ coughing, wheezing & diminished breath sounds
administer high flow o2
what is not associated with esophageal atresia?
purulent nasal discharge
what can be used to evaluate size of VSD?
Echocardiogram
what would be the first priority if admitted for bacterial endocarditis?
obtain blood cultures
if a HF patient is recieving Furosemide (Lasix) what is needed?
Administer O2
why give O2 to a patient with HF & receiving lasix?
pulmonary congestion from fluid back up into lungs
how much of the arm should the BP cuff cover
at least 80
A child with Truncus arteriosus, has hyptension & poor perfusion - what med should be administered?
Clopidogrel (Plavix)
What is the education for post cardiac cath?
Bed rest for 6 hr & 2 weeks of quiet play with pressure dressing
